Strategies for Reducing the Frequency of Preeclampsia in Pregnancies with Insulin-Dependent Diabetes Mellitus

ABSTRACT

The object of this study was whether improving glycemic control and maintaining normal glycosylated hemoglobin (HbA_1c) through pregnancy can reduce the frequency of preeclampsia. One hundred and twenty-three complete medical records of pregnant insulin-dependent diabetics (IDDM) managed at Yale-New Haven Hospital from 1983 to 1993 were reviewed. Serial HbA_1c measurements and the occurrence of preeclampsia were recorded. Based on the change of HbA_1c values through the pregnancy, glycemic control was categorized into four groups: group 1, high to normal; group 2, high to high; group 3, normal to normal; group 4, normal to high. The association between HbA_1c change and the incidence of preeclampsia was analyzed by chi-square test and Fisher's exact test. Among 123 IDDM pregnancies, 40 (32.5%) developed preeclampsia. High HbA_1c levels at any time in IDDM pregnancies were associated with an increased incidence of preeclampsia (group 1 or 2 or 4 versus group 3). Reducing HbA_1c by improving glycemic control both before and during pregnancy resulted in a significantly lower incidence of pre-eclampsia (group 3 versus groups 1 +2+4, p <0.05). The best strategy for reducing the frequency of preeclampsia in IDDM pregnancies is by improving glycemic control before pregnancy.

Keywords

Preeclampsia - insulin-dependent diabetes mellitus - glycosylated hemoglobin